In the early phases of recovery and rehabilitation, the goals and milestone are quite obvious – settle the swelling, reduce pain, increase range of motion, start strengthening the right muscles, and improve function. For most, these goals are achieved and that’s great. However the trap is that being pain free and able to run again doesn’t necessarily mean that rehabilitation is complete.
On going deficits in strength, endurance, postural control, balance, proprioception, biomechanics, and confidence can all lead to an increase in the risk of sustaining a new injury, aggravating the old one, or creating a new set of problems. I see far too many people with these issues, sometimes years after their original injury.
So how do practitioners, athletes, and patients alike ensure that they complete their rehabilitation and successfully return to their desired activity? I have three key tips;
1. Emphasize late stage rehabilitation
It’s easy to burn through motivation, energy, and treatment funds in the early stages of knee rehabilitation. Some guidance and treatment is required, but efficiency with both the amount of rehabilitation and treatment time is required.
Once the stiffness and soreness from the knee resolves it is then time to really work on the rehabilitation. The aim should be to restore (at least), if not improve the strength and function to the affected lower limb compared to the pre injury state.
Discuss this upfront, at the start of the process, so everyone knows what’s coming.
2. Use objective criteria to allow return to sport
Traditionally, recovery and rehabilitation from a knee injury was progressed via a pre determined time line… 8 weeks for a Grade II MCL, 9-12 months for an ACL reconstruction. Whilst it’s good to have a rough estimate on a timeframe, recovery shouldn’t be measured by it.
A set of objective criteria that need to be satisfied before return to sport is permitted should be implemented into the plan. Evidence based tests take preference, but if there are “baseline” (pre-injury) measures that can be incorporated such as how much someone could squat, or vertically jump that’s useful too.
An “exam” at the end of the each stage of rehabilitation is a powerful motivator, and it works really well using the Melbourne ACL Rehabilitation Guide 2.0.
3. Include strategies to maintain good leg strength, balance, alignment, and control
People need to maintain good condition of their lower limb to help ensure the long-term health of their knee. Strength can deteriorate, and people can slip into their old habits with poor biomechanics.
An on going strength and conditioning program is also important. A program like the PEP or FIFA11+ is good following an ACL reconstruction, but I like to individualize these for each of my own patients to make each program specific to their sport, abilities, weaknesses, and goals.
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